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Cognitive-behavioural therapy (CBT) is an effective treatment for depressed adults. CBT interventions are complex, as they include multiple content components and can be delivered in different ways. We compared the effectiveness of different types of therapy, different components and combinations of components and aspects of delivery used in CBT interventions for adult depression. We conducted a systematic review of randomised controlled trials in adults with a primary diagnosis of depression, which included a CBT intervention. Outcomes were pooled using a component-level network meta-analysis. Our primary analysis classified interventions according to the type of therapy and delivery mode. We also fitted more advanced models to examine the effectiveness of each content component or combination of components. We included 91 studies and found strong evidence that CBT interventions yielded a larger short-term decrease in depression scores compared to treatment-as-usual, with a standardised difference in mean change of −1.11 (95% credible interval −1.62 to −0.60) for face-to-face CBT, −1.06 (−2.05 to −0.08) for hybrid CBT, and −0.59 (−1.20 to 0.02) for multimedia CBT, whereas wait list control showed a detrimental effect of 0.72 (0.09 to 1.35). We found no evidence of specific effects of any content components or combinations of components. Technology is increasingly used in the context of CBT interventions for depression. Multimedia and hybrid CBT might be as effective as face-to-face CBT, although results need to be interpreted cautiously. The effectiveness of specific combinations of content components and delivery formats remain unclear. Wait list controls should be avoided if possible.

Background: Cognitive Behavioural Therapy (CBT) aims to teach people skills to help them self-manage their depression. Trial evidence shows that CBT is an effective treatment for depression and individuals may experience benefits long-term. However, there is little research about individuals’ continued use of CBT skills once treatment has finished. Aims: To explore whether individuals who had attended at least 12 sessions of CBT continued to use and value the CBT skills they had learnt during therapy. Method: Semi-structured interviews were held with participants from the CoBalT trial who had received CBT, approximately 4 years earlier. Interviews were audio-recorded, transcribed and analysed thematically. Results: 20 participants were interviewed. Analysis of the interviews suggested that individuals who viewed CBT as a learning process, at the time of treatment, recalled and used specific skills to manage their depression once treatment had finished. In contrast, individuals who viewed CBT only as an opportunity to talk about their problems did not appear to utilize any of the CBT skills they had been taught and reported struggling to manage their depression once treatment had ended. Conclusions: Our findings suggest individuals may value and use CBT skills if they engage with CBT as a learning opportunity at the time of treatment. Our findings underline the importance of the educational model in CBT and the need to emphasize this to individuals receiving treatment.

Meta-analyses suggest that reboxetine may be less effective than other antidepressants. Such comparisons may be biased by lower adherence to reboxetine and subsequent handling of missing outcome data. This study illustrates how to adjust for differential non-adherence and hence derive an unbiased estimate of the efficacy of reboxetine compared with citalopram in primary care patients with depression.

Method

A structural mean modelling (SMM) approach was used to generate adherence-adjusted estimates of the efficacy of reboxetine compared with citalopram using GENetic and clinical Predictors Of treatment response in Depression (GENPOD) trial data. Intention-to-treat (ITT) analyses were performed to compare estimates of effectiveness with results from previous meta-analyses.

Results

At 6 weeks, 92% of those randomized to citalopram were still taking their medication, compared with 72% of those randomized to reboxetine. In ITT analysis, there was only weak evidence that those on reboxetine had a slightly worse outcome than those on citalopram [adjusted difference in mean Beck Depression Inventory (BDI) scores: 1.19, 95% confidence interval (CI) –0.52 to 2.90, p = 0.17]. There was no evidence of a difference in efficacy when differential non-adherence was accounted for using the SMM approach for mean BDI (–0.29, 95% CI –3.04 to 2.46, p = 0.84) or the other mental health outcomes.

Conclusions

There was no evidence of a difference in the efficacy of reboxetine and citalopram when these drugs are taken and tolerated by depressed patients. The SMM approach can be implemented in standard statistical software to adjust for differential non-adherence and generate unbiased estimates of treatment efficacy for comparisons of two (or more) active interventions.

People with dementia living in residential care often face the dual disadvantage of increasing difficulty with communication and reduced opportunities for conversation. Social interaction is central to wellbeing of residents with dementia, so it is important that care staff have the skills to engage in conversation with them. We studied conversations in 20 care staff–resident dyads, to examine conversation structure and content, patterns of engagement within conversations, including the topics around which engagement occurred, and communication behaviours by care staff that appeared to facilitate (or impede) participation by residents. The transcripts were analysed using Discursis, a computational information visualisation tool that allows interactive visual inspection, in context, of the contributions by each speaker, the turn-taking dynamics, and the content recurring within and between speakers. We present case examples (a) where care staff did most of the talking, initiated topics and were responsible for most recurrence of content; (b) where talk was more evenly shared between partners, with some topics initiated and/or elaborated by participants with dementia; and (c) where participants with dementia talked most, with care staff supporting the conversation. We identified accommodative strategies used by care staff, such as reflecting back the other person's responses to sustain engagement. We also noted care staff behaviours that impeded communication, such as not listening attentively and not allowing sufficient time for responses. The results from this study highlight aspects of social communication within the aged care context and suggest ways in which rewarding interactions between staff and residents with dementia might be encouraged.

Childhood cardiac arrhythmias may have a long-lasting impact on a family and typically require long-term medical follow-up. Whereas some arrhythmias are benign, others can be life threatening and require significant medical care. As with many chronic illnesses, it is important to study the potential psychosocial effects of childhood arrhythmias and how they may impact a child's quality of life. The purpose of this study was to create a quality of life measure specific to childhood arrhythmias and to describe the current psychosocial functioning of this population. A total of 46 families participated in a one-time paper and pencil assessment during their regularly scheduled clinic visits. Results indicated promise for the validity and reliability of this new measure. Children in the current sample also demonstrated a high degree of resiliency. Additional analyses with larger samples will be needed to verify the psychometric properties of this measure. Overall, the high functioning of many of these children despite medical trauma is promising. Future studies should consider using some screening measures to decide which children may be most in need of intervention.

Two interstadial tree ring-width chronologies from Geikie Inlet, Glacier Bay Southeast, Alaska were built from 40 logs. One of these chronologies has been calendar dated to AD 224–999 (775 yr) crossdating with a living ring-width chronology from Prince William Sound, Alaska. Trees in this chronology were likely killed through inundation by sediments and meltwater from the advancing Geikie Glacier and its tributaries ca. AD 850. The earlier tree-ring chronology spans 545 yr and is a floating ring-width series tied to radiocarbon ages of about 3000 cal yr BP. This tree-ring work indicates two intervals of glacial expansion by the Geikie Glacier system toward the main trunk glacier in Glacier Bay between 3400 and 3000 cal yr BP and again about AD 850. The timing of both expansions is consistent with patterns of ice advance at tidewater glaciers in other parts of Alaska and British Columbia about the same time, and with a relative sea-level history from just outside Glacier Bay in Icy Strait. This emerging tree-ring dated history builds on previous radiocarbon-based glacial histories and is the first study to use tree-ring dating to assign calendar dates to glacial activity for Glacier Bay.

An enzyme immunoassay has been developed to semi-quantitate the degree of activation of platelets adhering to biomaterials. The method employs a monoclonal mouse anti-GMP-140 antibody. The glycoprotein GMP-140 is contained in alpha granules of resting platelets and is translocated to the outer membrane of platelets during activation via the thrombin-dependent pathway. A polyclonal anti-mouse IgG peroxidase conjugate is then added and platelet activation can be semi-quantitated by use of a suitable substrate, such as OPD.

The results obtained by this method compare well with scanning electron microscopy, and are shown to be less prone to the misinterpretation often associated with other conventional assay systems such as the determination of platelet adhesion by detection of ATP.

The adhesion and activation of platelets by biomaterials has been compared before and after coating these materials with phosphorylcholine (PC) derivatives. PC, in its form as a headgroup in membrane phosphoglyceride (lecithin) and ceramide (sphingomyelin) is a ubiquitous component of cell membranes, and displays extremely low interaction and binding with plasma proteins such as Factor XII [1,2], complement [2], fibrinogen [3,2], immunoglobulins [2] and albumin [2,4].

Using the immunoassay described here activation of platelets is seen to be dramatically reduced after coating surfaces, such as polyethylene, with PC compared with the untreated control. A PCcoated surface should therefore be an ideal starting point for developing tissue-inducing biomaterials. In addition endothelial cells contain GMP-140 in their secretory granules [5]. This would make this assay a potential tool in the investigation of endothelial cell - biomaterial interaction.

Theory and models of crop yield loss from weed competition have led to decision models to help growers choose cost-effective weed management. These models are available for multiple-species weed communities in a single season of several crops. Growers also rely on crop rotation for weed control, yet theory and models of weed population dynamics have not led to similar tools for planning of crop rotations for cost-effective weed management. Obstacles have been the complexity of modeling the dynamics of multiple populations of weed species compared to a single species and lack of data. We developed a method to use limited, readily observed data to simulate population dynamics and crop yield loss of multiple-species weed communities in response to crop rotation, tillage system, and specific weed management tactics. Our method is based on the general theory of density dependence of plant productivity and extensive use of rectangular hyperbolic equations for describing crop yield loss as a function of weed density. Only two density-independent parameters are required for each species to represent differences in seed bank mortality, emergence, and maximum seed production. One equation is used to model crop yield loss and density-dependent weed seed production as a function of crop and weed density, relative time of weed and crop emergence, and differences among species in competitive ability. The model has been parameterized for six crops and 15 weeds, and limited evaluation indicates predictions are accurate enough to highlight potential weed problems and solutions when comparing alternative crop rotations for a field. The model has been incorporated into a decision support tool for whole-farm management so growers in the Central Great Plains of the United States can compare alternative crop rotations and how their choice influences farm income, herbicide use, and control of weeds in their fields.

Alcohol is commonly considered to be associated with persistence of common mental disorder (CMD; anxiety/depression). However no community-based longitudinal studies have investigated the direction of causality.

Method

We examined the association between alcohol consumption and recovery from CMD using data on 706 community-based subjects with CMD who were followed for 18 months. Alcohol consumption at baseline was defined as hazardous drinking [Alcohol Use Disorders Identification Test (AUDIT) ⩾8], binge drinking (defined as six or more units of alcohol on one occasion, approximately two to three pints of commercially sold beer) and dependence.

Results

When compared with a non-binge-drinking group, non-recovery at follow-up was associated with binge drinking on at least a monthly basis at baseline, although the confidence interval (CI) included unity [adjusted odds ratio (OR) 1.47, 95% CI 0.89–2.45]. There was also weak evidence that alcohol dependence was associated with non-recovery (adjusted OR 1.37, 95% CI 0.67–2.81). There was little evidence to support hazardous drinking as a risk factor for non-recovery (adjusted OR 1.12, 95% CI 0.67–1.88).

Conclusions

Binge drinking may be a potential risk factor for non-recovery from CMD, although the possibility of no effect cannot be excluded. Larger studies are required to refute or confirm this finding.

There is conflicting evidence regarding the effect of depression during pregnancy on birth weight. We used data from the Avon Longitudinal Study of Parents and Children to investigate whether depressive symptoms during pregnancy in 10 967 women led to low birth weight at term in their offspring. Those with a high depressive symptom score during pregnancy were more likely to have babies of low birth weight (95% CI 1.16–2.40, P < 0.01), but this attenuated after adjustment for confounders (OR = 1.29, 95% CI 0.87–1.91, P = 0.210). Hence there is little evidence of an independent association between depressive symptoms during pregnancy and birth weight.

Studies quantifying weed seed production as a function of weed density are expensive and difficult, and lack of these data is a common limitation in modeling weed population dynamics over time. Observed empirical and theoretical relationships between crop yield loss curves and weed seed production curves led us to the hypothesis that there should be a strong relationship between the shapes of these two curves. Data from literature sources were evaluated to test this hypothesis for hyperbolic curves and to determine if the data describing the crop yield loss caused by weeds could provide estimates of the shape parameter of a hyperbolic equation for describing density dependence in weed reproduction. For each of 162 data sets, a shape parameter (N50) and a scale parameter (U) were estimated for an increasing hyperbolic model both for absolute crop yield loss as a function of weed density (N50YL, UYL) and for weed yield (either total biomass yield or seed yield) as a function of weed density (N50WY, UWY). N50YL was strongly correlated with N50WY across all data sets, with an apparent 1:1 relationship between the two. This relationship suggests that the shape parameter of the yield loss model may substitute for the shape parameter of a hyperbolic model describing the density-dependence of weed seed production. This substitution will be most useful in weed population modeling situations where data describing crop yield loss as a function of weed density are already available, but data describing weed seed production as a function of weed density are not available.

Wing feather mite burdens on seven species of passerine birds (Carduelis carduelis – goldfinch; C. chloris – greenfinch; Serinus serinus – serin; Sylvia atricapilla – blackcap; Sylvia melanocephala – Sardinian warbler; Turdus merula – blackbird; Passer domesticus – house sparrow) from Portugal were assessed by the subjective semi-quantitative scoring system of Behnke et al. (1995) in order to evaluate more fully the accuracy and reliability of the technique. Our analysis indicated that in all species, scores allocated to flight feathers showed a significant positive relationship with mite counts as assessed through microscopical examination of the same feathers. However, there were differences between species of birds. Of the species examined, goldfinches and greenfinches showed the weakest relationships between assigned mite scores and actual mite numbers indicating that the technique was less accurate when applied to these species compared with the remaining five. No evidence was found that anything more was to be gained from scoring both wings, rather than just one. Feather mites (Proctophyllodes spp., Trouessartia incisa) were also detected on tail feathers, but the assessment of these feathers presented additional problems and it was concluded that in the interests of minimizing handling time of birds, tail scores had little more to offer. We conclude that scoring all the flight feathers (including all primary, secondary, and tertiary feathers) on one entire wing, but alternating between left and right wings of birds within a species, represents an acceptable compromise between sufficiently detailed examination and minimization of bird handling time in the field.

A soil sampler, elutriator, and associated sample flushing device were designed and constructed for an intensive study of weed seedbanks. This equipment was used in 1993 to collect and process 4980 soil samples. The sampler was durable, core size was consistent, and sampling was efficient. Cores were approximately 200 cm3 and two people could take 120 cores/h. The elutriator separated weed seeds from 36 of these cores at a time. Washing required 60 to 75 min depending on soil texture. Seeds as small as 0.3 mm in diam were recovered and almost 100% of the seeds were recovered from samples spiked with barnyardgrass, redroot pigweed, velvetleaf, and witchgrass. The flushing device was used to transfer sample contents from strainers of the elutriator to propyltex bags for drying and storing. Equipment like this, plus improved technology for identifying and counting seeds, is needed to make weed seedbank studies more feasible.

Tardive dyskinesia (TD) may be mediated through free radical damage to neurons. Plasma lipid peroxide levels are a measure of radical damage to fats. Vitamin E is a free radical scavenger.

Method

One hundred and twenty-eight schizophrenic patients were examined for TD using the Abnormal Involuntary Movements Scale. Blood samples were taken to measure plasma lipid peroxide, serum vitamin E and cholesterol, and vitamin Exholesterol ratios. Twenty-four patients were also examined in October 1993, January 1994, and April 1994. Biochemical results were compared in 81 patients and 79 normal subjects.

Results

Patients with and without TD did not differ in median plasma lipid peroxide and serum vitamin E levels, or vitamin Exholesterol ratios. Correlations between seasonal change scores in TD and biochemical measurements were low. Lipid peroxide levels were higher and vitamin Exholesterol ratios lower in patients than in normal subjects. Vitamin E levels were lowest in in-patients and in those living in supported accommodation.

Conclusions

The results do not support the hypothesis that TD is mediated through free radical damage to neurons, but suggest increased free radical activity in schizophrenia.

In a double-blind study of 38 chronic schizophrenic in-patients, haloperidol decanoate was compared with fluphenazine decanoate as maintenance therapy over 60 weeks. Both drugs were given by injection at 4-week intervals. Haloperidol and fluphenazine were assumed to be equipotent; the mean starting dose of the former was 127 mg and of the latter 106 mg. The number of withdrawals over 60 weeks was similar in both groups but relapses, strictly defined, were significantly more frequent in the haloperidol group. When patients were switched to haloperidol, Parkinsonism diminished more quickly than in the fluphenazine group, but after 60 weeks there was no difference in severity in the two drug groups. The higher relapse rate and the quicker reduction in Parkinsonism in the haloperidol group might be due to a misjudgement in equivalent doses of the two drugs. Plasma haloperidol steady state levels were reached in most patients by 8–12 weeks. Plasma neuroleptic and prolactin levels, week-by-week systemic drug availability and Parkinsonism showed less variation between injections with haloperidol than with fluphenazine.

Eleven male chronic schizophrenics were given, serially, oral pimozide, fluphenazine, and flupenthixol; the two latter were also given intramuscularly as decanoates in oil. Oral haloperidol was given before and after each drug. Analysis of variance of steady state plasma levels of the different neuroleptics showed considerable within-individual variation in such levels, probably due to differences in absorption and metabolism and between routes of administration. The findings suggest that if a patient fails to respond to one neuroleptic, there may be good pharmacokinetic reasons for switching him to another belonging to a different group, or for giving the same neuroleptic by a different route of administration. The study also showed that previous administration of one neurololeptic may influence the steady state level of another. The various neuroleptics produced different effects on plasma prolactin levels.

In a double-blind trial, 34 male chronic schizophrenic day-patients or in-patients in a hostel ward continued on fluphenazine decanoate given mostly once fortnightly or were switched to pimozide, given on four days each week. Over nine months relapse rates were similar for both groups, and while fewer patients on pimozide were prescribed antiparkinsonian drugs one quarter developed buccolingual-masticatory dyskinesia. Plasma pimozide levels suggested satisfactory drug compliance. Average plasma prolactin levels were within the normal range for untreated men in one quarter of non-relapsing patients on pimozide and three quarters on fluphenazine.

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